Provider Demographics
NPI:1427410307
Name:TUCKER, JACKIE
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JACKIE
Other - Middle Name:HENRY
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3023 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3464
Mailing Address - Country:US
Mailing Address - Phone:225-405-4732
Mailing Address - Fax:
Practice Address - Street 1:3023 SARATOGA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3464
Practice Address - Country:US
Practice Address - Phone:225-405-4732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional